When Cure Becomes an Illness—Abuse of Addictive Prescription Medicines - Serbia

Psychoactive substance addiction presents a challenging public health issue worldwide particularly targeting vulnerable adolescent population (Babor et al., 2007). The illegal market turnover of the controlled substances is very difficult to trace and intervene timely among the young in the early stage of illness (Inciardi et al., 2007). Contrary to this one, legally regulated pharmaceuticals pose another dangerous threat that is more accessible to the authorities. In order to combat substance dependence the national strategies should specially emphasize prescription medicines with proven potential of abuse and addiction (Compton and Volkow, 2006).

Serbia as the largest Western Balkans market and a typical Eastern European transitional health system might serve as an appropriate example of medicines abuse in the EU borderlands (Jakovljevic, 2013). The results of local research in 2008, showed that 15.1% of first grade high school students, at least once had used, some psychoactive substance (excluding nicotine and alcohol), while 7.6% of them used sedatives, which was the most common [European School Survey Project on Alcohol and Other Drugs (ESSPAD), 2008]. The national survey on life styles of citizens in Serbia in 2014 about substance use and gambling addiction reported that in the past 12 months 22.4% of the respondents used sedatives, anxiolytics or hypnotics drugs (13.9% of males and 30.9% of females) and in the last 30 days 14.6% of respondents (8% of males and 21.2% of females) used these drugs with higher preponderance among older population. In the last 12 months 5.1% of the respondents used opioids for pain treatment (4.1% of males and 6.1% of females) and in the last 30 days 2.2% of respondents (1.6% of males and 2.8% of females) used these drugs. A large number of respondents said that they had purchased these drugs in the pharmacies prescribed by their physicians –85.3% of the population 18–64 years of age used hypnotics and sedatives, and 70.3% of the population used opioid drugs (Kilibarda et al., 2014).

Various studies have shown that drug addiction disorders are related to personality disorders, anxiety disorders and a considerably higher suicide rate (Regier et al., 1990). Further consequences of drug addiction are: education (Yamada et al., 1993) and employment underachievement, reduced work productivity, poor health, higher rates of human immunodeficiency virus (HIV) and hepatitis B and C infections (Jakovljevic et al., 2013a), social dysfunction, higher rate of violence and incarceration among that population, poverty, homelessness, a lower probability of recovery, poor treatment outcomes, and poor quality of life. The treatment system for substance use disorders is accompanied by high public and private expenses (Jovanovic and Jakovljevic, 2011).

Table 1

National level dispensing (Defined Daily Doses per 1000 population/day) and consumption (€) of major potentially addictive medicines and those used to treat substance addiction in 2004 and 2013 in Serbia.

ATC code group	Reimbursed value of dispensed medicines in 2004	Reimbursed value of dispensed medicines in 2013	DDD per 1000 inhabitants/hospital day in 2004	DDD per 1000 inhabitants/hospital day in 2013
POTENTIALLY ADDICTIVE MEDICINES
N01A Anesthetics, General	€1,283,128	€4,072,544	N/A	N/A
N01AF Barbiturates, plain	€21,465	€101,8422009	N/A	N/A
N02A Opioids	€1,472,459	€2,499,864	0.84	0.52
N02AA Natural opium alkaloids	€197,341	€611,410	0.04	0.08
N02AB Phenylpiperidine derivatives	€272,205	€1,341,574	0.03	0.11
N02AD Benzomorphan derivatives	€818	€5062006	0.00	N/A
N02AX Other opioids (mostly tramadol based preparations)	€1,002,095	€546,880	0.77	0.33
N03AA Barbiturates and derivatives	€427,676	€263,570	2.9	2.03
N03AE Benzodiazepine derivatives	€291,568	€1,288,405	0.63	2.48
N05AH Diazepines, oxazepines, thiazepines, and oxepines	€1,529,558	€4,925,668	0.37	1.53
N05B Anxiolytics	€9,450,094	€15,091,052	106.95	79.81
N05BA Benzodiazepine derivatives	€9,448,412	€15,091,052	106.95	79.81
N05C Hypnotics and sedatives	€1,197,390	€2,232,897	2.47	4.02
N05CD Benzodiazepine derivatives	€1,197,390	€1,459,522	2.47	1.98
N05CF Benzodiazepine related drugs	€0	€773,375	0.00	2.03
N06B Psychostimulants, agents used for ADHD and nootropics	€287,766	€3,138,433	0.35	6.61
R01AA Sympathomimetics, plain (mostly ephedrine based preparations)	€1,676,145	€4,328,551	132.14	14.83
R05DA Opium alkaloids and derivatives	€74,118	€28,649	0.05	0.03
R06AB Substituted alkylamines (mostly pheniramine derivatives)	€492,461	€2,764,304	0.56	0.08
MEDICINES USED TO TREAT SUBSTANCE ADDICTION
N07B Drugs used in addictive disorders	€236,734	€1,900,777	0.31	1.50
N07BA Drugs used in nicotine dependence	€138,139	€407,718	0.03	0.10
N07BB Drugs used in alcohol dependence	€35,123	€206,726	0.19	0.53
N07BC Drugs used in opioid dependence	€63,472	€1,286,332	0.09	0.88

Full article at: http://goo.gl/q0oRli

By: Mihajlo (Michael) Jakovljevic,1,* Marija Lazarevic,2 Milena Jurisevic,2 and Mirjana R. Jovanovic3,4

1Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

2Department of Pharmacy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

3Department of Psychiatry, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia

4Psychiatry Clinic, University Clinical Center Kragujevac, Kragujevac, Serbia

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